Health Burden of Tobacco

In South Africa in 2016 there were almost 26,000 smoking-attributable deaths for smokers aged 35-75.

The tobacco industry is promoting  e-cigarettes as a ‘healthy’ alternative but the long-term health impacts are still unknown.

This page presents research on the health burden of tobacco, including the estimated annual deaths in South Africa from tobacco-related causes and the cost of treating tobacco-related diseases in South Africa. Tobacco has negative health consequences and this page includes sections on the impact of smoking cigarettes, the impact of secondhand and thirdhand smoke, health conditions associated with farming tobacco, and the impact of using e-cigarettes.

Research on the relationship between tobacco use and COVID-19 is still developing.

What is clear is that current and former smokers are more likely to have severe COVID-19 symptoms if they contract the disease. We will continue to follow the ongoing academic research and update the TCDI website as information becomes available.

To learn more about the data and methods used in this page click here.

Smoking can harm nearly all systems in the human body, and causes many diseases, including lung cancer, which is the leading cause of cancer deaths in South Africa.

Global studies show that cigarette smoking is linked to 80%-90% of lung cancer deaths.


Caused by Smoking Cigarettes

Annual Deaths

from Smoking in South Africa

Using recent research published in South Africa

, the infographic shows how smoking causes disease and death. A significant share of deaths were attributed to either ‘Heart Diseases/Hypertension’, ‘Respiratory Diseases’, or ‘Cancers (Digestive/Respiratory System)’. Most deaths, however, were attributed to one of a variety of Other Smoking-Related Diseases, including vitamin deficiencies, thyroid issues, and rheumatic diseases. Higher smoking prevalence rates among men means that more men die as a result of smoking.

Deaths due to smoking in South Africa were predominantly caused by respiratory problems, heart disease and issues related to blood pressure, and cancers.

These figures underestimate the direct health burden to smokers because only those who have died from tobacco-related illnesses are counted. Those who are sick but still alive, or those who have been exposed to second-hand smoke are excluded.

Alternative research, which unfortunately did not state the sampling and research methodology making comparison with other research difficult, estimates the total annual deaths in South Africa attributable to smoking at 42 100 people


209,275 South Africans

138,738 men

70,537 women

were admitted into hospital because of smoking-related diseases in 2016.

Tobacco-related illnesses cost the South African economy R42 billion in 2016. R28 billion of this cost is due to (a) illness-caused productivity losses and (b) the losses in potential earnings for those who died prematurely. The remaining R14 billion is due to direct healthcare costs. But the tobacco industry only paid R12 billion in excise taxes in the same year.

In other words, for every 1 rand the government receives from the tobacco industry, it spends more than three rands. In other words, the tobacco industry causes a net loss to the South African economy.

* These figures were calculated using average earnings in South Africa and taking unemployment rates into account. The R14 billion reflects approximately 4.1% of overall healthcare expenditure.

Exposure to secondhand smoke is responsible for the deaths of more than 880,000 individuals worldwide every year.

Secondhand smoke contains more than 7,000 chemicals, 70 of which can cause cancer, and hundreds more that are toxic. About half of secondhand smoke comes from the smouldering butt of a cigarette and the other half from exhaled smoke.

Research on the effect of secondhand smoke is ongoing; the conditions that are causally linked to secondhand smoke are shown here.


about Secondhand Smoke

Tobacco is a labour-intensive crop.

Hand harvesting remains the preferred method, as tobacco leaves mature at different rates, machinery is expensive, and leaves picked mechanically are of lower quality. Farm workers can face risks from pesticides and other chemicals if safety protocols are not adhered to, and may also suffer from heat exhaustion during harvesting.

Read more on tobacco agriculture in South Africa.

Green tobacco sickness

Farm workers can protect themselves by wearing protective clothing, but they can still be at risk if their clothing becomes saturated with rain, dew or perspiration.

Some symptoms of green tobacco sickness are similar to those of heat exhaustion and pesticide poisoning. If healthcare workers are not familiar with this illness, it may be misdiagnosed.

Green Tobacco Sickness

Exposure Symptoms


Symptoms appear within 1 day of exposure and will last between 1 and 3 days.

Common Symptoms:

• Nausea
• Vomiting
• Dizziness
• Headaches

Other Symptoms:

• Difficulty eating
• Difficulty sleeping
• Weakness
• Abdominal cramps
• Shortness of breath
• Fluctuations in blood pressure and heart rate
• Pallor (unhealthy/pale/ashy appearance)
• Diarrhoea
• Chills
• Increased perspiration and saliva


about Green Tobacco Sickness

There is a lack of research on green tobacco sickness in Africa. Symptoms are similar to those of other ailments faced by farm workers (e.g., heat exhaustion) and can be misdiagnosed. Even when farmers and farm workers are aware of green tobacco sickness, there is misinformation about the causes and how to prevent it.

E-cigarettes (electronic cigarettes) are devices that produce an inhaled aerosol by heating a liquid that contains a solvent, one or more flavourings, and usually nicotine. Although e-cigarettes deliver nicotine differently to conventional cigarettes, they are still harmful to users’ health.


in E-Cigarettes

E-cigarette aerosol is NOT harmless “water vapor.”

lungs icon

The e-cigarette aerosol that users breathe from the device may contain harmful substances including: nicotine, ultrafine particles that can be inhaled deep into the lungs, flavorings such as diacetyl (a chemical linked to a serious lung disease), volatile organic compounds, cancer-causing chemicals, and heavy metals such as nickel, tin, and lead.

brain icon

The uptake of e-cigarettes by adolescents and young adults is a growing public health concern globally. Most e-cigarettes contain nicotine which can be harmful to brain development.

E-cigarettes are a new product and their long-term effects are unknown. More research needs to be done on the short- and long-term health effects of e-cigarettes.

The sale or distribution of e-cigarettes is banned in 41 countries globally, including 4 African countries: Ethiopia, Gambia, Mauritius, and Uganda.